Pre-exposure prophylaxis (PrEP) can reduce HIV transmission among gay and bisexual men (GBM). However, stigma can inhibit disclosure of PrEP use, which may limit uptake. This study's purpose was to explore PrEP disclosure experiences and how disclosure is associated with PrEP adherence among GBM at a sexual health clinic in Guatemala City. We conducted in-depth interviews with PrEP users (n = 18) and used an iterative content analysis approach. All participants had or planned to disclose their PrEP use to at least one person, most commonly friends and sex partners, though many were selective about who they told. Main reasons for disclosure were to educate others, gain social support, and clarify their HIV status. Concerns about stigma and emotional discomfort deterred disclosure. Disclosure facilitated PrEP access and adherence by enhancing emotional and instrumental support. Interventions providing opportunities for GBM to practice disclosure, including addressing others' misconceptions, could promote PrEP uptake and adherence.